Provider Demographics
NPI:1326750837
Name:CUNNINGHAM, SHAQUONDA (LMT)
Entity Type:Individual
Prefix:
First Name:SHAQUONDA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NW 8TH CT APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6846
Mailing Address - Country:US
Mailing Address - Phone:954-931-9126
Mailing Address - Fax:
Practice Address - Street 1:2300 NW 8TH CT APT 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6846
Practice Address - Country:US
Practice Address - Phone:954-931-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist